Urinary bladder cancer

Symptoms Of Urinary Bladder Cancer 

Bladder cancer symptoms can vary depending on the stage and type of cancer, but common signs and symptoms may include:

• Blood in urine (hematuria)
• Frequent urination
• Painful urination
• Feeling a sudden, strong urge to urinate.
• Having trouble urinating or experiencing weak urine flow
• Urinary tract infections (UTIs)
• Pelvic or back pain

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Types Of Urinary Bladder Cancer

Bladder cancer can be described based on its invasiveness:

1. Noninvasive: This includes growths that haven't spread deep into the bladder.

2. Non-muscle-invasive: Also known as stage I, it has not penetrated the muscle layer of the bladder.

3. Muscle-invasive: Cancer has spread into the bladder muscle, potentially affecting surrounding tissues or organs.

Causes Of Urinary Bladder Cancer

Changes occurring in the DNA of normal bladder cells can lead to abnormal growth and cancer formation. DNA is the basic building block in our cells that carries genes, which control how we look and how our body works.
Specific genes govern the growth, division, and survival of cells:

• Oncogenes: These genes promote cell growth, division, and longevity.

• Tumor suppressor genes: They typically regulate cell division, DNA repair, and programmed cell death.
  
  

The onset of cancer can be attributed to DNA alterations, known as gene mutations, which either activate oncogenes or deactivate tumor suppressor genes. Multiple gene mutations are typically required for a cell to progress into cancer.

Risk Factors For Urinary Bladder Cancer

Certain factors increase the risk of bladder cancer. These include:

1. Lifestyle factors

• Smoking
  
  

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• Dehydration

• Obesity

2. Medical history

• Chronic bladder infections

• Personal history of bladder cancer

• Chemotherapy or radiation therapy (drugs like cyclophosphamide or pelvic radiation elevate risk)

• Certain medications and herbal supplements 

3. Genetics

• Genetics and family history

4. Environmental Exposures

• Workplace exposures (chemicals from dye, rubber, leather, and textiles heighten risk)

• Arsenic in drinking water

Diagnosis Of Urinary Bladder Cancer

Understanding the staging of urinary bladder cancer is crucial for accurate diagnosis and treatment planning. The TNM staging system is commonly used for this purpose:

• T stands for Tumor, indicating the extent of tumor invasion into the bladder wall.

• N stands for Lymph Nodes, reflecting whether the cancer has spread to nearby lymph nodes and the extent of lymph node involvement.

• M stands for Metastasis, indicating whether the cancer has spread to distant organs or tissues.

Based on these factors, urinary bladder cancer is categorized into four stages:

Stage 0: Cancer is limited to the inner layer of the bladder lining or consists of very early, high-grade cancer cells confined to the inner layer.

Stage 1: Cancer in the bladder's inner lining but hasn’t invaded the muscular bladder wall.

Stage 2: Cancer has invaded the bladder wall but is still confined to the bladder.

Stage 3: Cancer cells spread through the bladder wall to surrounding tissue or may involve nearby organs or lymph nodes.

Stage 4: Cancer has spread to lymph nodes and other organs like the abdominal wall, pelvic area, lymph nodes beyond the pelvis, or other organs such as bones, lungs, or liver.

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Here are some of the common diagnostic measures used:

1. Medical history and physical examination

A doctor will review your medical history, including any risk factors such as smoking, exposure to certain chemicals, or a family history of bladder cancer. They will also perform a physical examination to check for any signs or symptoms of bladder cancer.

2. Urinalysis

This involves analyzing a urine sample to check for blood in the urine (hematuria), which can be a sign of bladder cancer. Urinalysis may also detect other abnormalities such as infection or urinary stones.

3. Cystoscopy

This is a procedure in which a thin, flexible tube with a camera (cystoscope) is inserted into the bladder through the urethra. This allows the doctor to visually examine the inside of the bladder for any abnormal growths or signs of cancer.

4. Biopsy/Transurethral resection of bladder tumor (TURBT)

If abnormal tissue is detected during a cystoscopy, the doctor will perform a biopsy. It involves removing a small tissue sample for microscopic examination. This procedure, known as transurethral bladder tumor resection (TURBT), is a surgical method used to assess and treat bladder abnormalities.

5. Urine tumor marker test

 Analyzes urine samples in the lab to detect substances produced by bladder cancer cells, aiding in the diagnosis of certain types of bladder cancer.

6. Imaging tests

Various imaging tests may be used to evaluate the bladder and surrounding structures, including:

• Ultrasound: An ultrasound uses sound waves to create a picture of the internal organs. It can help find out if the kidneys or ureters are blocked.
  
  

• Computed tomography (CT) scan: Uses x-rays and a computer to create detailed images of the body, including the bladder, helping to determine the extent of cancer spread.

• Magnetic resonance imaging (MRI): Uses magnetic fields and radio waves to generate detailed pictures of the bladder.

• Chest X-ray: Examines the organs and bones within the chest to check for signs of cancer spread.

• Bone scan: Involves injecting a small amount of radioactive material into the bloodstream to identify potential metastasis of bladder cancer to the bones.

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Prevention Of Urinary Bladder Cancer

Bladder cancer prevention primarily involves minimizing exposure to known risk factors and adopting healthy lifestyle habits. Here are some tips:

1. Maintain a healthy diet

• Consume a balanced diet rich in fruits, vegetables, and whole grains.

• Limit intake of processed meats and foods high in saturated fats. 

• Some studies suggest that certain nutrients like vitamins A, C, D, and E, as well as folate and selenium, may protect against bladder cancer.

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2. Stop smoking

Smoking is the leading risk factor for bladder cancer. Quitting smoking or avoiding exposure to secondhand smoke can significantly reduce the risk. 

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3. Minimize workplace chemical exposure

• Limit contact with harmful substances in high-risk industries like dye, rubber industry etc.

• Use protective gear and follow safety guidelines while handling chemicals

4. Maintain a healthy weight

Obesity has been linked to an increased risk of bladder cancer. Aim to achieve and maintain a healthy weight through a combination of regular physical activity and a balanced diet.

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5. Be active

Engage in regular physical activity, as it helps maintain a healthy weight, boosts the immune system, and reduces inflammation, potentially lowering the risk of cancer.

6. Practice safe sex

Protecting yourself from sexually transmitted infections may reduce the risk of certain types of bladder cancer associated with these infections.

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7. Manage chronic bladder issues

Seek treatment for chronic bladder inflammation or infections promptly to reduce long-term irritation and potential cancer risk.

8. Know your family history

If you have a family history of bladder cancer or other related cancers, inform your doctor for additional screening or preventive measures.

Specialist To Visit 

Cancer requires comprehensive care. Doctors who take care of patients with bladder cancer and help in diagnosing and formulating a treatment plan are:

• General physician
• Urologist
• Oncologist
• Surgical oncologist
• Radiologist
• Nephrologist

A general physician diagnoses initial symptoms, orders preliminary tests, and refers individuals to specialists.

A urologist specializes in diagnosing and treating conditions of the urinary tract, including bladder cancer.

An oncologist develops and oversees cancer treatment plans, including chemotherapy, immunotherapy, and targeted therapy, to manage bladder cancer and prevent recurrence.

A surgical oncologist performs surgical procedures to remove cancerous tissue and restore bladder function.

A radiologist interprets imaging tests to aid in diagnosing bladder cancer, staging the disease, and monitoring treatment response.

A nephrologist assists in managing complications like kidney dysfunction secondary to urinary obstruction or metastasis in advanced bladder cancer cases.

A palliative care clinicians focus on symptom management, incorporating diagnostic findings to provide supportive care, alleviate pain, and enhance quality of life in advanced bladder cancer patients.

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Treatment Of Urinary Bladder Cancer

The treatment of urinary bladder cancer depends on various factors such as the stage and grade of the cancer, the person’s overall health, and whether the cancer has spread to other parts of the body. Treatment options may include:

I. Surgery

• Transurethral resection of bladder tumor (TURBT): This procedure involves the removal of the tumor through a cystoscope inserted into the bladder through the urethra. It is commonly used for non-invasive or early-stage bladder cancer.
  
  

• Partial cystectomy: This removes part of the bladder, often for low-grade tumors confined to a specific area.
  
  

• Radical cystectomy with urinary diversion: This removes the entire bladder and surrounding cancerous tissue, sometimes requiring reconstruction to facilitate urine passage.
  
  

II. Chemotherapy

1. Intravesical chemotherapy: Chemotherapy drugs are delivered directly into the bladder through a catheter. This approach is often used after TURBT to reduce the risk of cancer recurrence. Drugs used are:

• Mitomycin
• Docetaxel
• Gemcitabine

2. Systemic chemotherapy: Chemotherapy drugs are administered orally or through a vein to reach cancer cells throughout the body. It may be used before or after surgery to shrink tumors, kill remaining cancer cells, or treat metastatic disease. Drugs include: 

• Carboplatin
• Cisplatin
• Doxorubicin
• Fluorouracil
• Paclitaxel
• Vinblastine

III. Immunotherapy

This therapy enhances the body's immune system to combat cancer cells. Drugs used include: 

• Avelumab
• Nivolumab
• Pembrolizumab
  
  

IV. Targeted therapy

This therapy targets specific molecules involved in cancer cell growth and spread. Drugs used for bladder cancer treatment include:

• Enfortumab vedotin
• Erdafitinib
• Ramucirumab

V. Radiation therapy

• External beam radiation therapy: High-energy radiation is directed at the bladder from outside the body to destroy cancer cells.
  
  

• Internal radiation therapy (brachytherapy): Radioactive material is placed inside the bladder temporarily or permanently to deliver radiation directly to the cancerous tissue.

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Home-care For Urinary Bladder Cancer

Caring for yourself at home after a bladder cancer diagnosis or surgery is essential for your recovery and overall well-being. Here are some general tips for self-care:

1. Follow your doctor's instructions: Adhere strictly to the instructions by your doctor on medications, dietary changes, and activity restrictions.

2. Pain management: If you experience any pain or discomfort, follow your doctor's recommendations for pain relief medication. 

3. Stay hydrated: Drinking fluids is crucial, especially after bladder surgery. However, consult with your doctor about the appropriate amount and type of fluids to consume.

4. Manage urinary symptoms: Consult your doctor for management strategies like pelvic floor exercises, bladder training, etc if you experience urinary incontinence or bladder symptoms.

5. Monitor for signs of infection: Look for symptoms of urinary tract infections (UTIs), such as burning with urination, frequent urination, cloudy or foul-smelling urine, and fever. 

6. Practice good hygiene: Keep the surgical incision site clean and dry to prevent infection. 

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7. Stay active: While it's essential to rest and allow your body to heal, light physical activity can promote circulation and aid in recovery. Follow your doctor's recommendations regarding exercise and activity level.

8. Maintain a healthy diet: Eat a well-balanced diet rich in fruits, vegetables, lean proteins, and whole grains. 

Foods to include:

• Fruits: Apples, berries, citrus fruits which are rich in vitamins and antioxidants

• Vegetables: Broccoli, green leafy vegetables, cucumber, etc

• Whole grains: Brown rice, quinoa, whole wheat bread as these high fiber and nutrients.

• Protein sources: Poultry, fish, beans, nuts which are essential for healing and energy.

• Beneficial fats: Nuts, olive oil, fish may lower bladder cancer risk, especially in females.
  
  

Foods to avoid:

• Limit intake of red meat and processed meats

• Avoid sugar-sweetened beverages and processed foods 

• Minimize consumption of white bread and pastries

Every individual's situation is unique, so it's crucial to consult with a dietician for personalized guidance and recommendations based on your specific needs and circumstances.
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Complications Of Urinary Bladder Cancer

Urinary bladder cancer can lead to various complications, some of which include:

I. Tumor-related complications

• Weight loss: As a tumor grows, it can put extra strain on the body, making it burn more energy while also reducing appetite. This can lead to unintended weight loss.

• Fatigue: Chronic inflammation and metabolic changes from tumor growth can cause severe fatigue in people with bladder cancer.
  
  

• Urinary tract infections (UTIs): Tumors can disrupt normal bladder function, leading to incomplete emptying increasing the risk of recurrent UTIs.

• Spread (metastasis): Bladder cancer can spread to nearby tissues and organs, such as the pelvic wall, prostate (in men), or uterus (in women). It can also metastasize to distant organs like the liver, lungs, or bones.
  
  

• Ureteral obstruction: Ureters, are the two tubes that carry urine from the kidneys to the bladder. Bladder tumors can block urine flow, causing retention, difficulty urinating, and potential kidney damage.

• Pelvic pain: Bladder cancer can cause pain in the pelvic region, lower back, or abdomen, especially if the tumor has invaded nearby tissues or organs.
  
  

• Anemia: Blood in the urine (hematuria) is a common symptom of bladder cancer. It can lead to anemia (low red blood cell count) if significant blood loss occurs over time.
  
  

II. Adverse effects of surgery

• Urinary leak: Urine leakage from surgical sites can occur, necessitating prompt intervention to prevent complications.
  
  

• Pouch stones: Urinary diversions, like continent pouches, can sometimes lead to stone formation inside the pouch, which may block urine flow or cause infections.

• Erectile dysfunction: In males, surgical procedures such as radical cystectomy (removal of the bladder) can damage nerves and blood vessels involved in achieving and maintaining an erection.
  
  

• Vaginal narrowing: In females, surgical procedures involving the removal of the bladder or radiation therapy can lead to scarring and narrowing of the vaginal canal, potentially affecting sexual function and comfort.

Alternative Therapies For Urinary Bladder Cancer

Certain therapies may support cancer management, but they should never replace standard treatments. Always check with your doctor before adding them to your routine.

1. Acupuncture

This traditional Chinese medicine technique involves the insertion of thin needles into specific points on the body to stimulate energy flow and promote healing. Acupuncture may help alleviate pain, nausea, and fatigue associated with bladder cancer and its treatments.

2. Mind-body practices

Techniques such as meditation, yoga, and guided imagery can help reduce stress, anxiety, and depression, which are common emotional concerns for individuals with bladder cancer. These practices may also improve sleep quality and promote relaxation.

3. Massage therapy

Massage therapy can help relieve muscle tension, improve circulation, and promote relaxation. It may also provide pain relief and enhance emotional well-being. However, individuals with bladder cancer should inform their massage therapist about their condition and any treatment-related concerns, such as the presence of surgical scars or sensitivity in the pelvic area.

4. Exercise and physical activity

Regular exercise, tailored to individual abilities and preferences, can help maintain physical function, manage fatigue, and improve quality of life during bladder cancer treatment and recovery. Activities such as walking, swimming, and gentle stretching exercises may be beneficial.

5. Aromatherapy

Essential oils offer relaxation and stress relief, aiding in managing anxiety and nausea during bladder cancer treatment.

Living With Urinary Bladder Cancer

Living with urinary bladder cancer poses unique challenges for patients and caregivers alike. Recognizing that you're not alone is crucial. Caregivers provide vital support, including physical, emotional, and practical assistance. 

Key considerations for managing the situation include:

1. Coping with emotional turmoil

• Receiving a bladder cancer diagnosis can trigger emotions like shock, sadness, anxiety, and anger.

• Seek support from loved ones, join support groups, and explore palliative care options to manage emotional turmoil effectively.

2. Addressing physical side effects

• Monitor and document any new or changing side effects of bladder cancer treatment.

• Promptly inform healthcare providers to prevent worsening

• Maintain detailed records for effective communication with the healthcare team

• Seek treatment for long-term or late-developing side effects to support post-treatment well-being

3. Coping with physical changes and challenges:

• Bladder cancer and its treatments may lead to physical alterations like urinary issues and appearance changes

• Seek guidance from doctors on managing physical changes and gather information about post-treatment life

• Discuss concerns regarding intimacy (relationships and sex) and self-esteem openly with a doctor

4. Managing the financial stress

• Understand the full scope of treatment costs associated with bladder cancer

• Discuss financial concerns openly with loved ones or healthcare providers

• Explore support from organizations offering assistance with treatment-related expenses

5. Ensuring follow-up care

• Adhere to recommended follow-up appointments post-treatment.

• Schedule medical history reviews and physical examinations every 3 to 6 months for 1 to 2 years

• Continue with less frequent appointments after that for ongoing monitoring

Tips for Caregivers

• Offer encouragement and emotional support to people with bladder cancer 

• Understand the treatment process and assist with managing symptoms and medication

• Coordinated medical appointments and helped with personal care and household chores.

• Address insurance and billing matters on behalf of the patient.

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